Fillable Voter Registration And Information Update Form printable pdf download

Voter Registration and Information Update Form

Please read instructions carefully. Please type or print clearly with blue or black ink.

For further information, you may consult the Secretary of State’s website at: or call 1-877-767-6446.

Eligibility

Registering by Mail

If you register by mail and do not provide either a current Ohio driver’s

You are qualified to register to vote in Ohio if you meet all the

license number or the last four digits of your Social Security number,

following requirements:

please enclose with your application a copy of one of the following

1. You are a citizen of the United States.

forms of identification that shows your name and current address:

2. You will be at least 18 years old on or before the day of

the general election.

Current valid photo identification card, military identification, or

current (within one year) utility bill, bank statement, paycheck,

3. You will be a resident of Ohio for at least 30 days

government check or government document (except board of

immediately before the election in which you want to vote.

elections notifications) showing your name and current address.

4. You are not incarcerated (in jail or in prison) for a felony

conviction.

Residency Requirements

5. You have not been declared incompetent for voting

Your voting residence is the location that you consider to be a

permanent, not a temporary, residence. Your voting residence is the

purposes by a probate court.

place in which your habitation is fixed and to which, whenever you

6. You have not been permanently disenfranchised for

are absent, you intend to return. If you do not have a fixed place of

violations of election laws.

habitation, but you are a consistent or regular inhabitant of a shelter or

other location to which you intend to return, you may use that shelter

Use this form to register to vote or to update your current Ohio

or other location as your residence for purposes of registering to vote.

registration if you have changed your address or name.

If you have questions about your specific residency circumstances, you

may contact your local board of elections for further information.

NOTICE:

This form must be received or postmarked by the 30th day

before an election at which you intend to vote. You will be notified by

Your Signature

your county board of elections of the location where you vote. If you

In the area below the arrow in Box 14, please write your cursive,

do not receive a notice following timely submission of this form, please

hand-written signature or make your legal mark, taking care that it

contact your county board of elections.

does not touch the surrounding lines so when it is digitally imaged by

your county board of elections it can effectively be used to identify your

Numbers 1 and 2 below are required by law. You must answer both

signature.

of the questions for your registration to be processed.

Please see information on back of this form to learn how to

obtain an absentee ballot.

Registering in Person

If you have a current valid Ohio driver’s license, you must provide that

WHOEVER COMMITS ELECTION FALSIFICATION IS

number on line 10. If you do not have an Ohio driver’s license, you must

provide the last four digits of your Social Security number on line 10. If

GUILTY OF A FELONY OF THE FIFTH DEGREE.

you have neither, please write “None.”

FOLD HERE

I am:

Registering as an Ohio voter

Updating my name

Updating my address

1. Are you a U.S. citizen?

Yes

2. Will you be at least 18 years of age on or before the next general election?

Yes

If you answered NO to either of the questions, do not complete this form.

3. Last Name

First Name

Middle Name or Initial

Jr., II, etc.

4. House Number and Street (Enter new address if changed)

Apt. or Lot #

5. City or Post Office

6. ZIP Code

7. Additional Rural or Mailing Address (if necessary)

8. County (where you live)

FOR BOARD

USE ONLY

SEC4010 (Rev. 6/12)

9. Birthdate (MO-DAY-YR) (required) 10. Ohio driver’s license No. OR

Ohio Driver’s License No. OR

11. Phone No. (voluntary)

City, Village, Twp.

Last Four Digits of Social Security No.

last 4 digits of Social Security No.

(one form of ID required to be listed or provided)

Ward

12. PREVIOUS ADDRESS IF UPDATING CURRENT REGISTRATION - Previous House Number and Street

Precinct

Previous City or Post Office

County

State

School Dist.

13. CHANGE OF NAME ONLY Former Legal Name

Former Signature

Cong. Dist.

14.

Date_______/_______/_______

Your Signature

I declare under penalty of

DAY

election falsification I am a

Senate Dist.

citizen of the United States, will

have lived in this state for 30

House Dist.

days immediately preceding

the next election, and will be

at least 18 years of age at the

time of the general election.

Voter Registration And Information Update Form

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